Intensificación de dosis con radioterapia conformacional 3D en cáncer de próstata: ？Más dosis es mejor?

purpose: the present study was undertaken to determine the effect of radiation dose on biochemical control and morbidity in prostate cancer patients. materials and methods: between 1995 and 2003, 360 patients with t1-t3b prostate cancer were treated in a sequential radiation dose escalation trial from 66.0 to 82.6 gy. these patients were prospectively assigned to 1 of 3 prognostic groups according to risk factors: a) low risk patients were treated with 3dcrt alone; b) intermediate risk patients were allocated to receive neoadjuvant ad (nad) 4-6 months prior and during 3dcrt; and c) highrisk received nad and adjuvant ad (aad) 2 years after 3dcrt. rtog/eortc toxicity score was used to analyze late complications results: median follow-up was 48 months (12-138). the actuarial biochemical disease free survival (bdfs) at 4 years for low risk, intermediate risk and high risk patients was 88%, 68% and 79% respectively. stratified and multivariate analysis showed that higher radiation dose (>76 gy) (p=0.0053) and the use of aad for high risk patients (p=0.0046) correlated significantly with an improvement of bdfs for all patients. the incidence of late grade 2 rectal and urinary bleeding were 7% and 11% respectively. conclusion: the present study confirms an independent benefit of high-dose (> 76 gy) radiation therapy and long-term aad in high-risk prostate cancer patients.